[Severe hyponatremia and comatose state during colonoscopy preparation]

Authors present a case of an 83 years old female, who suddenly became unconscious and had seizures, during bowel preparation for colonoscopy, but before taking the sodium phosphate purgative. Laboratory investigations revealed severe hyponatremia. Hypertonic saline infusion was administered, the electrolyte disturbance returned to normal, the patient slowly regained her consciousness and her disorientation started to improve gradually. Hyponatremia was likely induced by stress provoked ADH secretion, due to the patients' fear for bowel cleansing and colonoscopy, and by large fluid intake consumed as "misunderstanding" of the instructions. The aim of this case presentation is to call attention to the risks of colonoscopy preparation, which threaten those patients who follow the physicians' instructions exorbitantly, and to demonstrate the treatment of the acute hyponatremia.